Starting a care business in Maine

Maine's CON law, 22 M.R.S. chapter 103-A, defines a "health care facility" as a hospital, psychiatric hospital, nursing facility, kidney disease treatment center, rehabilitation facility, ambulatory surgical facility or one of several imaging, cardiac and cancer centers. Assisted living, residential care, adult day, home care and child care are not on that list, so opening one needs no CON. Residential care still crosses the CON unit's desk. DLC's Healthcare Oversight program says some residential care projects, including new facilities, improvements and changes of ownership, need prior approval under the residential care reimbursement rule, 10-144 C.M.R. Ch. 115; its 2025 CON annual report puts that as approval of any increase in licensed beds or any transaction costing more than $500,000. A nursing facility may convert nursing beds to residential care beds without a CON, but MaineCare pays for the converted beds only if the unit finds the added residential care cost fully offset by nursing facility savings, and it must weigh the effect on residential care facilities within 30 miles where occupancy there is below 80%. In 2024 it approved three such conversions and one residential care bed increase.

Residential care is sorted by floor plan under 10-144 C.M.R. Ch. 113, rewritten effective September 18, 2025. Private apartments with their own bathroom and food preparation area plus a common dining room make an assisted living facility under Part A, at $200 a year. Private or semi-private bedrooms make a residential care facility under Part B, at $10 per licensed bed a year (both fees as published in 22 M.R.S. §7854 on November 11, 2026), with the same license whether the home has two beds or more than sixteen; the old Levels I to IV no longer exist as license categories. DLC's compliance guidance for the rewrite told secure memory care units operating under an assisted living license to apply for residential care licensure. A residential care facility with a licensed capacity of seven or more residents needs an administrator licensed by the Nursing Home Administrators Licensing Board.

The step that holds up building-based licenses is the State Fire Marshal's Office. By statute DHHS may not issue a residential care license until the Department of Public Safety certifies fire compliance, and the Life Safety Code chapter you build to changes at 4 and at 17 beds. Assisted living projects that build or renovate need a Fire Marshal construction permit. An adult day services program, required once a paid group program serves more than two unrelated adults aged 19 or older, also waits on a signed Fire Marshal inspection report, as does every child care license.

In-home care is split by what the worker does. Help with daily living or household tasks needs a personal care agency license, which replaced registration on July 1, 2024 under Ch. 129; it requires a physical site in Maine, and DLC's page says it is running 6 to 9 months behind its usual timelines. Nurses, therapists, home health aides or CNAs need a home health care services license from DLC's Medical Facilities Unit, with a preliminary conference requested at least 45 days before the initial survey. Medicare certification is optional for the license, but MaineCare's Section 40 home health benefit pays only Medicare-certified agencies, and CMS stopped new Medicare home health enrollments on May 13, 2026 for six months; as of November 11, 2026 it had published no extension.

Child care thresholds changed in 2025. Under PL 2025, c. 135, a family child care provider license is required for 4 to 12 children under 13 in your home who are not your own, though the Ch. 33 rule text, checked on November 11, 2026, still says more than 2. Care for 3 or more children anywhere other than your home needs a child care facility license under Ch. 32, as a small facility (3 to 12 children), a center (13 or more) or a nursery school; a center must get a Fire Marshal construction permit before using any building, new or existing. Both licenses start provisional for 3 to 12 months, require water test results before licensure, and Ch. 33 requires family providers to enroll in Maine's Quality Rating and Improvement System.